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R Lattes

Publications and source records attributed to R Lattes.

At least 19 recordsLinked to original sources
PubMed2003

Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study.

OBJECTIVE: To analyze risk factors for Pneumocystis carinii pneumonia (PCP) in kidney transplant recipients. STUDY DESIGN: In a case-control study, 17 PCP cases diagnosed between July 1994 and July 2000 were matched with two controls each (previous and subsequent kidney transplant recipients who did not develop PCP during the same follow-up period). Demographics, organ origin, human leukocyte antigen (HLA) mismatches, use of poly- or monoclonal anti-CD3 antibodies (Po/MoAb) for induction or rejection treatment, rejection episodes, cumulative steroid dose for rejection treatment, immunosuppressive regimens, and other infections were analyzed. RESULTS: No significant differences were seen in gender (male 10 vs. 15), mean age (39.7 vs. 35.4 years), organ origin (cadaver donor 13 vs. 19), HLA mismatches, or Po/MoAb use in induction treatment. Significant differences were observed in PCP cases for rejection history (P=0.02), and median and total number of rejection episodes (P=0.0018). The relative risks for PCP for 1, 2, and > or =3 rejection treatments vs. no such treatment were 1, 1.05, and 6.30, respectively (P=0.021). The relative risk for PCP for steroid-resistant rejection was 4.34 (95% confidence interval [CI], 1.04-18.89) (P=0.019), and that for the use of Po/MoAb for rejection treatment was 7.23 (95% CI, 1.28-49.34) (P=0.006). The relative risk for PCP for 0, 1, and > or =2 previous or concomitant cytomegalovirus (CMV) infection vs. no such infections were 1.0, 2.32, and 13.0, respectively (P=0.012). The relative risks for PCP for tuberculosis (TB) was 18 (95% CI, 1.76-852.03), that for bacterial pneumonia was 14.22 (95% CI, 2.16-150.23), and that for hepatitis C virus infection was 5.25 (95% CI, 1.03-28.91). Immunosuppressive regimens with tacrolimus, mycophenolate mofetil (MMF), steroids (P=0.06), and MMF as a single variable (P=0.05) were more frequently used in cases. Primary trimethoprim-sulfamethoxazole prophylaxis failure was observed in 12 patients in association with heavy immunosuppression and concomitant infections. CONCLUSIONS: The risk of PCP in kidney transplant recipients is related to the number and type of rejection treatments. It is also related to the occurrence of CMV infection, and to other immunomodulating infections such as TB and hepatitis C, and might also be increased with the use of newer and more potent immunosuppressive agents. Primary prophylaxis failure may occur in association with some of these risk factors.

Adult↗
PubMed1999

Tuberculosis in renal transplant recipients.

Tuberculosis (TB) has been described in kidney transplant recipients as an infection with predominantly pulmonary involvement. We report the impact of TB in kidney transplantation. Clinical records of adult kidney recipients, transplanted between 1 January 1986 and 31 December 1995 were analyzed for sex, age, graft origin, immunosuppressive therapy, TB sites, diagnostic methods and concomitant infections. Annual incidence, mean time of onset, relation to rejection treatment, tuberculin skin test (PPD) and outcome were analyzed. Patients with a history of TB or graft loss in the first month were excluded. TB was diagnosed in 14 of 384 (3.64%). Mean age at transplantation was 35 years. Twelve of these received the graft from a living donor. All had triple immunosuppression with cyclosporine. Ten had pulmonary TB, three extrapulmonary infection and one disseminated disease. In 13 cases an invasive diagnostic procedure was performed. Mycobacterium tuberculosis cultures were positive in all cases; microscopy revealed acid-fast bacilli (AFB) in 6, and adenosine deaminase was elevated in CSF and pleural effusion in 2. Annual incidence varied from 0% to 3.1%. At the time of TB presentation 8 patients had other concomitant infections (cytomegalovirus, nocardia, Pneumocystis carinii, disseminated herpes simplex virus). Median time of onset was 13 months. Diagnostic results became available post-mortem in 2 cases, and one had TB in a failing allograft. TB was treated with 4 drugs including rifampin in 10 patients. Cyclosporine was discontinued in one, lowered in one and increased in 8. During treatment 5 patients had rejection episodes. At 1 year, graft survival was 72.7% and patient survival 90.9%. TB was more prevalent when recipient and donor were both PPD positive. In summary: although TB is a growing threat in the transplant setting, early and aggressive diagnosis with meticulous monitoring of immunosuppression allows a successful outcome for both patient and graft. Optimal prophylaxis guidelines have yet to be completely defined.

Adult↗
PubMed1997

Immunohistochemical and molecular genetic approaches to soft tissue tumor diagnosis: a primer.

During the past two decades we have witnessed the identification of an expanding list of immunohistochemical and molecular markers linked to histopathologically defined subtypes of tumors. These markers offer new insights and approaches to the classification of tumors with important prognostic and/or therapeutic implications. We review the potentially diagnostic immunohistochemical and molecular markers of soft tissue tumors (STTs). The immunohistochemical markers reviewed include vimentin, cytokeratin, desmin, HHF35, S100, myoD1, alpha1-antitrypsin, vascular markers (factor VIII, CD31, CD34), MIC2, and others. The potentially diagnostic chromosomal translocations and associated genes identified in STT include Ewing's/PNET t(11;22)(q24;q12)(FLI1;EWS), t(21;22)(q22;q12)(ERG; EWS); t(7;22)(p22;q12)(ETV1;EWS); desmoplastic small round cell tumor t(11;22)(p13;q12)(WT1;EWS); extraskeletal myxoid chondrosarcoma t(9;22)(q22;q12) (TEC(CHN);EWS); malignant ectomesenchymoma t(11;22)(q24;q12)(FLI1;EWS); alveolar rhabdomyosarcoma t(2;13)(q35;q14)(PAX-3;FKHR); t(1;13) (p36;q14)(PAX-7;FKHR); myxoid and round cell liposarcoma t(12;16)(q13;p11)(CHOP;TLS(FUS)); synovial sarcoma t(X;18)(p11;q11)(SSX1&2;SYT), and others. The nature, utility, and limitations of these markers in diagnostic settings are explored.

Biomarkers, Tumor↗
PubMed1996

Lobular neoplasia. Long term risk of breast cancer and relation to other factors.

BACKGROUND: Lobular neoplasia (LN), also known as lobular carcinoma in situ, is an incidental histologic finding in tissue removed at breast surgery. Patients with LN are known to be predisposed to develop invasive or intraductal carcinoma (CA). This study investigates factors that influence the cancer risk in LN patients. METHODS: Analysis of data concerning long term follow-up (median: 18 yrs) of 236 patients with LN identified in a pathologic review of more than 2000 biopsy specimens with benign epithelial proliferative breast disease. RESULTS: The probability of CA developing in either breast in long term survivors after a biopsy that contained LN was approximately 1/3, which is 5.4 times (95% CI: 4.2 - 7.0) the rate in the general population. The relative risk (RR) tended to decrease with increasing age at diagnosis, but was approximately doubled (RR: 1.8; 95% CI: 1.1-3.2) for patients with benign epithelial breast disease preceding their initial diagnosis of LN. CA risk remained markedly elevated for at least 20 years, and increased substantially if there was a second operation showing LN- from 4.9 (95% CI: 3.7-6.4) after a single operation with LN to 16.1 (95% CI: 6.9-31.8) after a second such operation. CONCLUSIONS: LN is a marker of increased CA risk that is further exacerbated by episodes of preexisting benign breast epithelial proliferative changes, and that remains substantially elevated for many years.

Adult↗
PubMed1995

Regression of skin recurrences of breast carcinomas treated with intralesional injections of natural interferons alpha and gamma.

Two groups of patients with disseminated breast carcinomas who had failed radiotherapy, chemotherapy, and hormonotherapy were treated with natural interferon alpha (nIFN-alpha) alone or in combination with nIFN-gamma delivered in cycles of 10-12 intralesional (i.l.) injections to recurrent and metastatic lesions. In group, I, 16 skin lesions in 12 patients received nIFN-alpha alone resulting in 7 complete regressions verified histologically (CR), 7 partial regressions (PR), and no regressions (NR) in 2. Group II included 4 patients in whom 7 cutaneous recurrences were treated with nIFN-alpha/nIFN-gamma (5 CR, 2 PR), 2 were injected with nIFN-alpha alone (1 CR, 1 PR), and 1 received nIFN-gamma alone (PR). Two additional patients in group II were given i.l. injections of nIFN-alpha/nIFN-gamma to lymph node metastases (1 CR, 1 PR). Clinical toxicity was experienced by 5 of 12 patients in group I and by all the patients in group II and was controlled in most instances by antipyretics. Systemic antitumor effects were not appreciable clinically. Nevertheless, noninjected lesions exposed only to systemic levels of IFNs, when studied immunohistochemically, displayed an immunological response similar to that of IFN-injected lesions, although less intense. Therefore, IFNs can be useful in controlling locoregional recurrences of breast cancer even in patients who are not responding to other forms of therapy. Furthermore, in addition to the local antitumor actions, they appear to be capable of eliciting systemic immunological effects.

Breast Neoplasms↗
PubMed1993

Prognostic significance of benign proliferative breast disease.

BACKGROUND: Recent studies concerning an association between benign breast diseases and risk of subsequent breast cancer have focused on benign proliferative lesions recognized in biopsy specimens. Some have implicated atypical hyperplasia as being associated with the greatest risk. METHODS: The histologic sections of specified benign breast lesions from 1799 women were reviewed and reclassified, using published criteria for proliferative disease. Prognostic significance was assessed by relating the pathologic findings to the development of breast cancer observed during an average 21 years of follow-up, in which time 157 women developed the disease. RESULTS: Benign proliferative changes were recognized in 85% of the patients, with a corresponding relative risk of subsequent carcinoma equal to 2.2 times population rates (95% confidence limits, 1.9 and 2.6). Increasing levels of hyperplasia and atypia in lobules or ducts were associated with modest increases in risk, ranging from 2.1 to 2.3 to 3.0 for proliferative changes with no atypia, mild atypia, and moderate to severe atypia, respectively. This trend was not statistically significant. The most significant risk indicators in this study were the presence of adenosis (relative risk, 3.7), and moderate or severe atypia in ducts (relative risk, 3.9). CONCLUSIONS: Benign proliferative breast disease recognized in biopsy specimens is associated with an increased risk of future breast cancer, but fine distinctions among levels of hyperplasia and atypia did not significantly distinguish risk among patients in this study.

Adolescent↗
PubMed1993

Reproducibility and validity of pathologic classifications of benign breast disease and implications for clinical applications.

BACKGROUND: Research studies on the relationship between benign breast diseases and cancer risk typically identify certain conditions as risk factors, and others as carrying no prognostic significance. This study addresses several issues concerning the relevance of such research results for advising individual patients in a clinical setting. METHODS: Data were obtained as part of a "blinded" retrospective pathology review of benign breast biopsies. A random sample of cases was reviewed twice, providing information about reliability. Comparisons with diagnoses that used information from the operative reports and gross pathology descriptions as well as microscopic histology were used to assess validity. RESULTS: Among cases that were reviewed twice, excellent agreement was achieved for diagnosing carcinoma and lobular neoplasia, good agreement for adenosis and intraductal papilloma, and relatively poor agreement about levels of hyperplasia and atypia, and whether ducts or lobules were involved. Distinctions among levels of hyperplasia also apparently were influenced by the number of slides available for review. The "blinded" review diagnoses frequently differed from the diagnoses that used all information available at the time of surgery in detecting the presence or absence of gross cystic disease, and in distinguishing solitary from multiple papillomas. CONCLUSIONS: Problems with reliability of precise distinctions among levels and sites of hyperplasia and atypia seem to limit the usefulness of such classifications as guidelines for individual patient care. For conditions with some clinical manifestations, diagnoses based exclusively on histologic review of biopsy specimens often are not accurate.

Breast↗
PubMed1991

Lipoblastic meningioma: "vacuolated meningioma".

This report describes and illustrates seven cases of benign meningeal tumors, including one in the retro-bulbar region of the orbit, which were characterized by vacuolated signet-ring cells. Occasional typical meningothelial areas were also seen; however, the signet-ring cells were the dominant feature. The vacuoles were consistently negative with the various stains for mucin. In one single case in which nonparaffin-embedded tissue was still available, the vacuoles were positive for fat stains. Immunohistochemical stains done in three of the cases showed that the tumor cells were positive for vimentin. S-100 protein was definitely positive in two cases and weakly positive in one. One of the three cases was positive for cytokeratin and another was positive for epithelial membrane antigen. The name "lipoblastic meningioma" appears to be acceptable as a descriptive term, since these tumors are, in our opinion, of definite meningeal origin, probably representing a predominantly mesenchymal (lipocytic) differentiation of the arachnoidal cells. This term, however, does not imply a clinical behavior analogous to that of true liposarcoma. In fact, these tumors have consistently behaved as benign local problems, analogous to the biologic course of ordinary meningioma.

Adult↗
PubMed1985

Cystosarcoma phyllodes. Report of an unusual case, with death due to intraneural extension to the central nervous system.

Cystosarcoma phyllodes tumors of the breast occasionally exhibit malignant behavior, including chest wall invasion, hematogenous spread or, rarely, metastasis by lymphatic routes. An unusual case of cystosarcoma is presented in which death was apparently caused by perineural and intraneural extension of the tumor along intercostal nerves, to the sympathetic chain, and then to the brain stem by spinal roots, with no evidence of embolic metastasis.

Adult↗
PubMed1982

Nodular (pseudosarcomatous) fasciitis, a nonrecurrent lesion: clinicopathologic study of 134 cases.

Clinicopathologic review of 134 patients originally diagnosed as having nodular (pseudosarcomatous) fasciitis is presented. In 114 patients with 116 lesions, no recurrence of the lesion was noted. Of the 114 patients, 85% were younger than 50 years of age, and the forearm and arm were the most common sites of presentation. Nonrecurrent lesions rarely exceed 4 cm and 71% were smaller than 2 cm. In at least six instances, incompletely resected lesions never recurred. Though all lesions were histologically reminiscent of reparative mesenchymal tissue, four subtypes--the reactive type, the densely cellular type, those with osteoid or cartilaginous metaplasia, and the so-called proliferative fasciitis--were distinguished from the majority of lesions that conform to the description given by Kornwaler. Recurrence of the tumor was noted in 18 patients. Fifteen of 18 lesions recurred within two years, and two more recurred at 30 months following initial excision. In all these cases, review of the histology and clinical course led to a revision of the original diagnosis. The greatest number of errors was made in incorrectly classifying of inflammatory fibrous histiocytoma. Recurrence of a lesion originally diagnosed as nodular fasciitis should lead to a careful reappraisal of the pathologic findings.

Adolescent↗